The changing horizon of acute coronary syndrome

Abstract

ST-elevation acute coronary syndromes are most commonly caused by thrombotic occlusion of an epicardial coronary artery. The immediate treatment goals are to re-establish coronary flow and to reduce clot burden as well as the risk of recurrent thrombus formation. Primary percutaneous coronary intervention (PCI), when delivered in a timely manner, is the preferred method to achieve reperfusion. 1 Keeley EC Boura JA Grines CL Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003; 361: 13-20 Summary Full Text Full Text PDF PubMed Scopus (3515) Google Scholar Drugs such as aspirin, thienopyridines, antithrombins, and glycoprotein IIb/IIIa antagonists are recommended by treatment guidelines 2 Antman EM Hand M Armstrong PW et al. 2007 focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008; 117: 296-329 Crossref PubMed Scopus (1044) Google Scholar , 3 Van de Werf F Bax J Betriu A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J. 2008; 29: 2909-2945 Crossref PubMed Scopus (1) Google Scholar in patients undergoing primary PCI to reduce periprocedural ischaemic events that are secondary to clot within the infarct-related artery. However, bleeding is a common complication resulting from administration of these adjunctive drugs, and occurs most frequently at the site of arterial access. Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trialIn patients with STEMI undergoing primary PCI, anticoagulation with bivalirudin reduced the rates of net adverse clinical events and major bleeding at 1 year compared with treatment with heparin plus a GPI. This finding has important clinical implications for the selection of optimum treatment strategies for patients with STEMI. Full-Text PDF